腹膜后解剖外血管旁路术在感染性腹主动脉瘤治疗中的应用  

Application of extra-anatomic prosthesis bypass in the retroperitoneum for the treatment of infected abdominal aortic aneurysms

作　　者：戚悠飞[1] 肖占祥[1] 舒畅[2] 曾昭凡[1] 岳劼[1] 刘飒华[1] 陈浩[1] 张文波[1] 

机构地区：[1]海南省人民医院血管外科,海口570311 [2]中南大学湘雅二医院血管外科

出　　处：《中华普通外科杂志》2017年第8期683-686,共4页Chinese Journal of General Surgery

基　　金：海南省社会发展科技专项基金资助项目（2015SF04）

摘　　要：目的探讨腹膜后解剖外血管旁路术在感染性腹主动脉瘤（infected abdominal aortic aneurysms．iAAAs）治疗中的应用价值。方法回顾10例行腹膜后解剖外血管旁路术＋瘤腔清创治疗的iAAAs患者的临床资料。所有患者围手术期均辅助抗感染治疗，出院后规律随访。结果本组10例iAAAs患者均采用腹膜后解剖外血管旁路术重建主髂动脉，血管重建完成后再行瘤腔清创。1例因主动脉十二指肠瘘行急诊手术，其余9例择期手术。所有患者术前行一次或多次CT检查以确诊，围手术期至少有一次血培养或组织培养阳性，其中沙门菌阳性5例。类鼻疽伯克霍尔德菌阳性3例、大肠杆菌阳性1例，肺炎克雷伯菌1例。患者围手术期无死亡，术后4～6周出院。随访期间，10例患者无发热、腹痛等感染复发或移植物感染表现。1例患者术后16个月不明原因死亡。结论腹膜后解剖外血管旁路术治疗iAAAs的临床效果满意，为iAAAs的治疗提供一种新的手术方式。Objective To assess the effectiveness of extra-anatomic prosthesis bypass in the retroperitoneum as a treatment for infected abdominal aortic aneurysms （iAAAs）. Methods We retrospectively reviewed the records of 10 consecutive patients diagnosed with iAAAs and treated by an extraanatomic prosthesis bypass in the retroperitoneum over the past 7 years. All 10 patients were regularly followed up by outpatient observation after their discharge. Results Ten patients with iAAAs underwent an extra-anatomic prosthesis bypass in the retroperitoneum and debridement of the infected aneurysm. An emergency operation was performed for one patient who underwent concomitant gastrointestinal procedures for aortoduodenal fistula, the other 9 cases underwent an elective operation after an intravenous antibiotic therapy for 2 - 4 weeks. All 10 patients were definitely diagnosed by one or more sequential CT scans combining with other methods. All patients had at least a positive preoperative blood culture or intraoperative tissue culture during the perioperative period, including Salmonella in 5 cases, Burkholderia pseudomallei in 3 cases, Escherichia coli in 1 case, Klebsiella pneumoniae in 1 case. All patients were discharged in 4 - 6 weeks after their operations. Except 1 case who died 16 months after surgery, all other patients were alive and were free from graft infection during the follow-up period. Conclusions The extra-anatomic prosthesis bypass in the retroperitoneum for treating iAAAs are safe and effective.

关 键 词：主动脉瘤 主动脉 腹 解剖外旁路术 腹膜后 移植物 

分 类 号：R654.3[医药卫生—外科学]